[The inhalation versus systemic prevention of pneumonitis during thoracic irradiation].
BACKGROUND
Pneumonitis is a typical subacute reaction of healthy bronchial tissue to thoracic irradiation. The purpose of the present trial was to show whether prophylactic application of steroids in the course of and following radiotherapy would reduce the incidence of pneumonitis.


METHODS
Fifty-seven patients receiving thoracic irradiation for bronchial carcinoma were assigned to 2 therapeutic groups; half of the patients were given 10 mg of oral prednisolone per day, while the other half received daily inhalative beclomethasone. All patients were evaluated for radiographic signs of pneumonitis. Thirty-two patients received additional investigations for pulmonary diffusion capacity of carbon monoxide.


RESULTS
The overall incidence of pneumonitis was 17.6% (10/57 patients). Neither total radiation dose nor mode of fractionation did significantly contribute to the incidence of pneumonitis. Those patients showing a pulmonary diffusion capacity for carbon monoxide of less than 60% prior to radiotherapy had a significantly higher risk of developing pneumonitis (4/7) than patients with a higher diffusion capacity (3/25, p = 0.026). In follow-up period we did not see significant changes in diffusion capacity neither with patients who developed pneumonitis nor with those patients showing no evidence of pulmonary injury. Comparing the chest X-ray there were less radiographic changes consistent with pneumonitis in the inhalative beclomethasone (2/28) than in the oral prednisolone group (8/29, p = 0.045).


CONCLUSIONS
In order to reduce the incidence of pneumonitis in patients receiving thoracic irradiation we support a continuous application of steroids in the course of and following radiotherapy. The inhalative use of beclomethasone has proved to be superior to oral prednisolone due to better local efficacy and decreased unwanted side effects.
Pagel
J
J
Abteilung Strahlentherapie, Klinik und Poliklinik für Radiologie, Friedrich-Schiller-Universität Jena.
Mohorn
M
M
Kloetzer
K H
KH
Fleck
M
M
Wendt
T G
TG
D000280:Administration, Inhalation; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001507:Beclomethasone / Q000008:administration & dosage; D002283:Carcinoma, Bronchogenic / Q000150:complications / Q000532:radiotherapy; D004318:Doxycycline / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000532:radiotherapy; D011239:Prednisolone / Q000008:administration & dosage; D017564:Radiation Pneumonitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D013902:Radiography, Thoracic; D011879:Radiotherapy Dosage; D013909:Thorax / Q000528:radiation effects*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D011239:Prednisolone; D001507:Beclomethasone; D004318:Doxycycline
Inhalative versus systemische Pneumonitisprophylaxe bei Thoraxbestrahlungen.